Dr. Gerard M. Nadal: Science in Service of the Pro-Life Movement

More Debate on the Phoenix Abortion

A recent graduate of my alma mater writes a few comments to tell me that she was taught in college that Catholic doctrine actually allows for abortion to save the life of the mother. Her other, more extended comment is here, along with my reply.

Erin
Frankly, it comes down to this:

A pregnant woman would have almost certainly died without an abortion. Had she died, her baby would have died as well. With the abortion, she had a chance to live. Either way, the baby is dead.

I understand your belief that it is better to let two people die “naturally” than deliberately end the life of one who was going to die anyway to save another.

However, let us consider this from the question of choice. Consider the fact that this woman was placed in a Catholic hospital and *could not be moved* due to the very serious condition she was in. Is it legitimate to say that regardless of what *she* wants, what *she* believes, regardless of the four living children she has waiting, a HOSPITAL (where she has gone for *life-saving* treatment) can deny her a procedure that would save her life? The end doesn’t justify the means? The “means” was going to happen either way! The baby was going to die!

I am very pro-choice but I do support the right of a religiously-affiliated hospital to choose not to provide abortions, birth control, etc. And yet, in the situation where a patient is dying, has absolutely no other options in terms of getting treatment, what then? I also cannot believe that a sister would flippantly “o.k.” an abortion if she did not clearly see that it was fit. I genuinely believe that her excommunication indicates an ongoing distrust of female opinion, particularly in the Catholic church.

Mr. Nadal, do you think you could stand there and tell that woman she could not continue to live because you couldn’t justify ending the life of a baby that was doomed to die in the next few hours anyway?

I would appreciate if you would read the post in the following link and share your thoughts:

I beg you to remember that because of HIPAA restrictions, it is interesting to note the level of detail being released by the hospital. In truth, nothing at all ought to have been released. They are leaking just enough information to spin the story their way.

Next, NPR is hardly the authoritative source of information when it comes to Roman Catholic Doctrine. Actually, the most authoritative voice in the matter is being dismissed, and that is a Roman Catholic Bishop, who is an Apostolic Successor speaking in his capacity and with authority as such. Bishop Olmsted also possesses a doctorate in Canon Law (Church Law). So, as both a doctor of Canon Law and a Bishop, I would expect that HIS would be the voice considered most authoritative on what the Church accepts as permissible. Instead, it is being derided by a media that thinks they know best what the Church teaches.

Next, I believe that you labor here under a false and misleading notion of what the Church teaches, specifically as you recall your education on the matter at St. John’s Univ. Either you were taught the principle of double-effect and you are making a mistaken application here, or you were taught erroneously by a theologian who was substituting their preferred view of the universe for established moral dogma and Canon Law.

As for the particulars of this case, as I have written, it is highly unlikely that this woman suddenly found herself in this condition at 11 weeks of pregnancy. You’ve seen the comments here on this blog from a pediatric cardiologist, who in her 20 years of this specialty has only seen three cases of sudden pulmonary hypertensive crisis, essentially one case every seven years. So my comments in the link provided above stand. It is highly unlikely that this woman suddenly found herself in this situation.

The position of the Church is clear. We do not directly and intentionally kill the baby to save the mother. If you ask if I were a physician, could I stand and tell the mother she had to die?

That’s the wrong question. As her physician, I would have told her from the outset that I do not abort babies. Period. I would have told her that St. Joseph’s will not abort babies. Period. I would have stressed that my job is to do all that I can to save BOTH mother and child and that I will do all within my power to do so. I would have advised that if the couple wanted to hold out therapeutic abortion as an option, that they see another physician with privileges at another hospital that permits abortion. (Not hard in a city as large as Phoenix). That’s the exercise of the woman’s legal choice in the matter.

I would refer you to the American Association of Pro-Life Obstetricians and Gynecologists for further inquiry from actual pro-life OB/GYN’s:

Again Erin, this is a very bad situation, made so by the failure of the hospital administration to lay down clear limits. Bishop Olmsted represents those limits with great fidelity.

Finally, I refer you to the case of Dr. Gianna Beretta Molla, a physician, wife and mother who chose the life of her baby over the abortion recommended to her. It cost her nothing less than her own life. Read about it here:

Her whole life was a protracted preparation for that one heroic and love-filled decision. Her life illustrates what is missing in this story, and that is the daily practice of virtue on the part of the nun who allowed for the direct and intentional death of the baby, as well as the physician who did the killing. Consider this quote from former US Senator Dan Coats:

Character cannot be summoned at the moment of crisis if it has been squandered by years of compromise and rationalization.

The only testing ground for the heroic is the mundane.

The only preparation for that one profound decision which can change a life, or even a nation, is those hundreds of half-conscious, self-defining, seemingly insignificant decisions made in private.

Habit is the daily battleground of character.

That’s why Sr. McBride has been excommunicated and Dr. Molla has been canonized a Saint.

40 Responses

I also agree that we likely don’t know all the details involved in the mother’s case.

There have also been many such instances in recent years of women who have forgone treatment while pregnant or have refused to abort and yet both mother and babies have survived.
In fact, by doing the latter, these courageous mothers have in fact helped to save the lives of mothers and babies coming after them.
We now know that many pregnant women can receive treatment for cancer after the first trimester.

I am reminded of a story that I read many years ago of a mother with TB. This was before the widespread use of antibiotics and the woman in question was very sick with a large abdominal cavity that was enlarging every day. I’m not sure if she had TB in the abdomen.
When she unexpectedly became pregnant her doctors told her she MUST abort the baby. She refused.
Instead the growing child closed the large hole inside her and healed her.
Both baby and mother survived.

I would like to come back to the example of a life-and-death moment in a pregnancy, where both mother and infant will die, and do a thought experiment. Because this does happen, even if rarely.

Establishing that-

Life is sacred. Life should not be taken.

Jeremiah 1:5 “Before I formed you in the womb I knew you.” God knows us, before we are formed in the womb.
If so, that means we are who we are always. In God’s image, whether we are 44 years old or 2 years old or 2 weeks after conception.

We are given free will.

John 15:13 “Greater love has no one than this, that he lay down his life for his friends.”

If these are permissible, then let’s also consider the following:
Mother and child both standing next to each other, outside of time, able to speak to one another. Both the mother and child are going to die because of illness during pregnancy.
What would the child say to the mother? What would the mother say to the child? Would the child condemn the mother should delivery be attempted?

I think the doctors should do all they can to save both the mother and the child. People born at 23 weeks are living now, normal and happy lives. I expect that with more attempts at saving younger babies there will be greater success at saving younger babies. Why not try to save both if both mother and baby are going to die? At the moment when the mother is in life-and-death crisis, the baby is delivered and both are given heroic measures to save lives. Until that moment the mother does everything she can to prolong the pregnancy to give the baby the best future possible.

Great quote from Dr. Molla. Thanks for posting it. I would just add that, in my humble opinion, private decisions are made after much observation and thought that includes experiences seeing other people living the right example.

Frankly, people should be considering such possibilities and making these kinds of choices before they ever seek to become pregnant. It is a moral, educational and even parental lapse that such issues are not confronted before males and females seek to engage in sexual activity. And, because abortion is legal it is all too easy to rely on it as a solution rather than to do what is correct according God’s Word.

If the Church’s position is always that a child may not be aborted to save the life of the mother – even if an abortion truly is what would save the mother, no matter how rare a situation it might be – then there is some credence to what pro-choicers say when they say that pro-lifers don’t care about the mother, a statement with which I, even given my pro-choice bias, have disagreed a bit. (In the spectrum of those of us who believe in a woman’s right to choice, I am on the more conservative side.) While I have not been a proactive pro-choicer – never marched, haven’t voted at all in almost 10 years – the clarification of this issue within the most prominent pro-life institution is causing me to reconsider my inactivity.

I was also aware of St. Gianna and the circumstances of her death, which included leaving her children without a mother. I know her husband survived, but what if something happened to him? I would not subject my surviving children to such chance and therefore would do everything in my power to live as long as I could to raise and protect my children. If that meant sacrificing one not yet born for the good of the others, as painful an option as that would be, then so be it.

JPT
But that is exactly the difference between Catholics/Christians and the rest of the world.
We recognize that our lives are comprised of both spiritual and material.
We look after ourselves as best we can, realizing of course that this life on earth is not guaranteed.
In the case of Gianna Molla, after her death, one of her children also died after her death.
Who can predict what might happen in our lives?
A mother whose life is saved by abortion today,might very well die on the way home from the hospital the next day.
And your last statement really means that you are willing to sacrifice one of your children to save the mother. Why does it matter whether the child is unborn or born?
Would you ever consider killing one of your born children to save the life of the mother?

If you accept the sloganeering of pro-choicers and pro-aborts as your norm, then of course moral theology and its resultant bioethics are going to sound rather alien and discordant to you. That’s a large part of the problem in the discourse here.

We start from the position of the Church that both mother and child have equal moral worth, equal human dignity. It is not for us to choose, or to decide that one or the other will live and the other will die.

It simply is not a morally legitimate choice.

Those who make such a choice arrogate to themselves the power that is God’s alone.

If you keep reading the new posts as I put them up, I am in the middle of a debate with a pediatric cardiologist, Dr. Judith Becker, on this issue. Even by her own reckoning, she has only seen three cases of acute pulmonary hypertension in a twenty year career as a specialist in the field. An average of one case every seven years. By her accounting, two of those women died after “days to weeks”. She has not answered me as to whether or not those women had abortions.

The entire purpose in studying bioethics, and in teaching it to medical professionals and scientists, is to train ourselves in the fundamental answers to fundamental questions of human identity and moral worth. The answers need to be in place before the crisis arises, not as arbitrary rules to be blinly obeyed, but as a direction based upon the certain knowledge of each individual’s worth and the rights that derive from that worth.

If pro-aborts believe that the mother has more rights, greater dignity and intrinsic value than her baby, then the course of action is clear enough. There are several hospitals in Phoenix where the abortion would be performed without needing ti impanel a bioethics committee.

However, the Roman Catholic Church has a vision of humanity that is quite different. In our vision, we view all humans as possessing equal dignity in God’s eyes. Dr. Gianna Molla chose the life of her child over her own life, knowing that she would be leaving her husband to raise them without her. She too made a “choice”.

But for all of the self-aggrandizing rhetoric from the pro-choice crowd, the only choice they deem acceptable is the death of a baby. Legitimate choice requires more than one option.

We choose life. We choose to attempt to save the life of both the mother and the child. We choose to refrain from killing. Those are our choices, legitimately and freely made.

Again, if the hospital and its staff were clear in their articulation of Catholic bioethical guidelines, then this couple would have sought another facility through which they could have pursued their care.

So in fact – I’m trying to have a discussion about this on another site – Catholic doctrine is just straightforwardly that in a situation such as occurred at St Joseph’s Hospital, under no circumstances ought a Catholic to allow the woman’s life to be saved?

NPR in fact confirms this with a quote from a Catholic theologian at Boston college: that the doctrinally correct thing to do would have been to deny the woman the abortion and let her die.

It is not for us to choose, or to decide that one or the other will live and the other will die.

I’m afraid the only possible response to that is: In that case, no Catholic hospital and no Catholic doctor ought ever to be in the position of providing medical services to pregnant women.

Because it’s impossible to be in that situation and not make choices. Refusing to provide an abortion that will save the life of a pregnant woman is itself a choice – it’s a choice that two deaths are better than one.

And no hospital with any medical standards ought to be providing care to patients with the caveat that under some circumstances, the hospital will uphold the principle that it’s better to let two die than to save the life of one.

Gianna Molla made that choice for herself.
Sr. MacBride and all the others were called on to make a choice for another person.

Seriously, Dr. Nadal? You would have sent the woman to another hospital? Given her drugs to treat the hypertension ? Watched her die? Your article of faith is more important than her life and her wishes?
Appallingly arrogant, smug and lacking in compassion.

The Roman Catholic Church is not a monolith. We do not have to follow without question. Bishop Olmsted and his ilk deny the right of conscience and would take us back to the days of the Inquisition. You may relish this prospect. Luckily, neither of you are the Church.

His declaration of automatic ex-communication is a cowardly attack on Sr. MacBride. The gloating here over the treatment Sr. MacBride received at the hands of the man who is supposed to be her pastor is sickening.

Bishops wrote Directive 47. They recognise that life is full of difficult choices, and we are all fallible.

I saw your comments on the other site and thank you for crossing over the great divide in coming here to hold a respectful conversation about a topic that elicits a great deal of passion. Welcome.

I think that it’s mischaracterization the Catholic position when you state:

“Catholic doctrine is just straightforwardly that in a situation such as occurred at St Joseph’s Hospital, under no circumstances ought a Catholic to allow the woman’s life to be saved?”

Though I can understand how people see it that way. The truth of the matter is that we see the baby as a human being with all of the dignity and full moral worth (which includes full standing under the law, both natural moral law and manmade positive law) as the mother. That’s the essential starting position for us, and if you are going to understand our position, then it’s imperative that you understand that we begin there. If one begins from a pro-choice, pro-abortion perspective, then of course the Catholic position seems absurd, because a pro-choice position does not recognize the humanity and moral standing of the baby.

However, proceeding from the starting position that the baby has the same humanity and full moral standing as the mother, it is an impossibility to choose who lives and who dies. We simply cannot assign to the baby the burden of responsibility for the mother’s deteriorating health, and then condemn it to death.

It also bears noting that a great many women have been told that they would die if they pursued their pregnancies further, only to have healthy babies and uneventful deliveries. So there is no absolutely certain outcome in most all cases. It would also be incredibly naive to overlook the fact that many OB/GYN’s practice a litigiously-motivated approach to patient care that errs in favor of the least-likely chance for a malpractice suit against the physician. Plenty of babies have been aborted in the name of this pernicious brand of defensive practice.

The case in Phoenix carried with it an immediacy, from what has been reported. However, I caution you to bear a few things in mind:

Under HIPAA privacy law, the hospital has released a certain amount of information about a patient that can allow those with knowledge of her to divulge her identity. They are playing a dangerously illegal and unethical game in releasing just enough information to spin the story in their favor.

They have left out critical details such as whether the woman was already being treated for the PHT, or whether this was an extremely rare case of acute and immediately life-threatening onset. The rarity of such an event points toward the probability of this having been subacute in the weeks prior to admission. If so, was she being treated medically? If so, was she counseled that the hospital could not perform an abortion in the event of an acute episode? For the hospital to have spoken as much as they did, but to leave out these pertinent factors adds to my suspicion that there were hidden agendas here.

Not a few nuns and doctors are in open rebellion against Catholic doctrine, and allow situations such as this to develop toward the crisis point in an attempt to force the issue of abortion, rather than counsel patients in an ethically appropriate manner before matters become acute. In so doing, they are cynically using the suffering of patients to advance their own agenda.

Nuns and doctors are not in rebellion against Catholic doctrine. They are engaging in reflection and debate about how best to live their lives in faith.
The people rebelling against Catholic doctrine are those who are trying to rollback Vatican II.

For many of your concerns, I direct you to my reply to Jesurgislac as a foundation for the comments that here follow.

Directive 47 does not envision direct killing of a baby, but covers the principle of double-effect wherein a diseased organ (containing a baby) that is the etiologic agent of an immediately life-threatening condition may be removed if there is no chance that leaving it intact will allow the mother to live long enough to bring the baby to the point of viability. Such examples are uterine cancer and tubal pregnancy.

Intent matters. In the aforementioned cases, the death of the child is not willed, and not sought as the means of saving the mother’s life.

That differs from the Phoenix abortion that envisions the baby as the immediate cause of maternal mortality.

Yes, I do envision treating the mother with drugs as an attempt to bring her safely to the point of the baby’s viability. That’s rational therapy that seeks to maximize the saving of both patient’s lives.

As for Bishop Olmsted, he simply stated Church Law, which is the subject of his doctorate. Formal cooperation in procured abortion is an evil so grave as to cause the guilty to incur automatic excommunication by the very act of their participation. It is intended as a medicinal remedy to bring the guilty to conversion of heart and reconciliation with God through sacramental confession. So contrary to your diatribe, Bishop Olmsted was acting as a very charitable pastor.

For the record, I edited whole chunks of your diatribe. That sort of invective is practiced by those who lack knowledge and insight, and who are guilty of primitive religious bigotry. It is always unwelcome here. Learn to disagree without being disagreeable and offensive.

Since I am being quoted in this string I feel I should speak for my self as I have being quoted out of context and though I answered Dr Nadals questions, he apparently did not see that portion of my response. I also asked for some clarifications of his response and I have not yet seen a response from him.
As you will read in my final entry on the prior string this morning, I would respond here as well to Dr Nadal, “You may argue this all you want from the perspective of canon law, but do not use my words to argue it from a medical perspective. And, if, in fact in it’s infinite wisdom, the church rules that it is less sinful to lose two lives than save one, I can understand why there is a crisis of faith.”

May 20 10:30 AM:
I am a pediatric cardiologist whose expertise is in fetal diagnosis and care. In this capacity I see patients with pulmonary hypertension far more frequently than my colleagues. I also see other complications of pregnancy as a direct result of my work. I have 3 times in my 20 years of practice seen patients turn up in an emergency room in pulmonary hypertensive crisis without having known they had significant pulmonary hypertension prior to that time. Two of those patients never left the hospital but rather died over days to weeks in out ICU. A patient in that condition may or may not be easy to transfer elsewhere, depending on how much support she needed. There are experimental medications for pulmonary hypertension (including viagra and similar pulmonary vasodilators) but these therapies have a spotty performance record and it would not be known for months whether they had done enough to improve the patients condition significantly. Pregnancy effects the heart in these mothers in two ways. First it puts an increased volume load on the heart which if already failing can push it over the edge. Then in the process of straining, the right heart can acutely fail with this disease leading to sudden death.

The upshot of all this is:
1 – Yes, the mother could have arrived at the hospital for the first time in poor condition, could have required stabilization and may have been too sick to move.
2 – An abortion early in the pregnancy of a patient like this is far safer than taking a wait and see
attitude.
3 – To deny this mother lifesaving medical care at the time of the admission denied her access to long term therapies that might save her life. Also without her survival, the fetus could not survive so on the logic of not killing the fetus, we condemn both to death or murder, if you like. We also deny the previously delivered children of this mother the care of that mother in the future.
As a physician, this is an ethically untenable position. We take an oath when we complete our training to do no harm…..In a terrible situation like the one being discussed therefore it is far better to save the mother than lose both the mother and the child.

May 20 12:35 AM
Dr Nadal I have to take issue with you on this case. As Linda points out and as you yourself say, no one knows all the details, yet further on in your article you then rush to judge that a Bishop’s but not a nun’s word should be taken for whether an ethical line was crossed. I would, given that none of us know the specifics, and that both sides of the issues are represented by those in God’s service, tend to respect the nun’s position since she was right there at the time hearing ALL the arguments on both sides. If that is not good enough, then how about bringing the case into the light (without exposing the name or identifying info of the patient) and let us all be presented with all the known facts on both sides before running to judge?

I know it’s a bit off issue, but why have there not been ANY excommunications of priests who are recognized by the community to have rape multiple children, but a nun is excommunicated in a murky controversy of preserving the rights of the mother over that of an ultimately nonviable fetus.

In answer to your questions about my post above, the two deaths I mentioned related to Pulmonary hypertension were not preceded by an abortion. We had another case where a young mother was admitted and found to have free aortic insufficiency (another abnormality where pregnancy can be lethal and is contraindicated). That mother was counseled that her best hope for a good outcome was to ‘terminate the pregnancy’ (medical terminology), have her aortic valve replaced, and then go on to become pregnant with a functioning valve. She did choose that course, and as a result has a healthy heart which will function properly in future gestations.

When you comment: “Other of your colleagues would beg to differ with you on this approach to the management of both patient’s lives.” I have to ask if those are physicians who have cared directly for patients with Pulmonary hypertension in this situation?

May 22 8:22AM:
Dr Nadal has chosen to speak for me but he is taking my words out of context to make his own case and in the process has no regard for his own warning that we do not know all the facts and therefore should be careful about our assumptions….he is over and over making a huge assumption and it is inappropriate for him to use my words to support that assumption when in fact I was suggesting he not assume and that the opposite could be true.

Let us be clear.
1 – Pulmonary hypertension is a terrible disease and is very commonly quite lethal
2 – It is something that cannot quickly or easily be fixed or even improved WITH ANY KNOW MEDICAL THERAPY. It carries an unacceptably high mortality rate when it occurs, and IT RARELY REARS IT’S HEAD BEFORE THE PATIENT IS QUITE ILL AND THE HEART IS FAILING bringing them to medical attention.
3 – Fortunately it is uncommon, BUT THAT IS VERY DIFFERENT FORM CONTENDING IT IS NOT LIKELY TO HAVE HAPPENED IN THIS CASE. If it was a common enough occurrence a consult to the ethics committee would not have been necessary.
3 – Fortunately it is an uncommon disease BUT it does happen and FROM A MEDICAL PERSPECTIVE, if that was the case, Sister McBride and her medical staff DID EVERYTHING RIGHT.

You may argue this all you want from the perspective of canon law, but do not use my words to argue it from a medical perspective. And, if, in fact in it’s infinite wisdom, the church rules that it is less sinful to lose two lives than save one, I can understand why there is a crisis of faith.

However, proceeding from the starting position that the baby has the same humanity and full moral standing as the mother, it is an impossibility to choose who lives and who dies.

Well, clearly it’s not impossible: the position that you take is that Catholic hospitals and doctors should choose to have both die.

The truth of the matter is that we see the woman as a human being with all of the dignity and full moral worth (which includes full standing under the law, both natural moral law and manmade positive law). Catholic doctrine with regard to abortion disregards the woman’s humanity, dignity, and moral worth as an essential starting position.

That you then argue that Catholics are required to see the fetus as equal to the woman can’t save the unborn fetus, because women according to this position have no value, and therefore the fetus has no value either.

Which explains neatly why Bishop Olmsted, and yourself, are advocating that Catholics let both die.

Of course I am pro-choice – I believe that if the woman decides not to have an abortion, that’s her right, too. I believe that no woman should be forced through abortion or pregnancy and childbirth against her will, and I certainly don’t believe that anyone should become a doctor, or run a hospital, when they advocate for the deaths of their patients regardless of their patient’s will.

I note that you praise Dr. Gianna Beretta Molla, a physician, wife and mother who chose the life of her baby over the abortion recommended to her. But you yourself advocate that neither she nor any other woman should be allowed to choose. By decrying the principle of choice and free-will, you make clear you do not regard any woman – not even a saint – as having moral worth.

You equate being “pro-choice” with “pro-abortion”. But you acknowledge that Doctor Molla made a choice, and was sainted for it. Do you seriously think it would have been better if Doctor Molla had simply been forced through pregnancy until she died of it, without ever being allowed any choice at all? You are advocating that Doctor Molla shouldn’t have been allowed to become a saint…

I was unaware that all hospitals, or even most in Phoenix are Catholic. Your comments lead one to that conclusion by suggesting that the death of the mother is the only option here.

There are other hospitals, as I have mentioned, for pro-choice people to avail themselves of the full range of choices available under the law. It is Catholics who are being compelled to act against their will and abiding beliefs by people who insist that we join the majority of hospitals in this nation in permitting the targeting of the pre-born for death. The truth is that there are other hospitals where abortion is permissible. In fact, it is at most hospitals.

As for equating pro-choice with pro-abortion, that is the reductio ad absurda of abortion’s proponents. Choice extends beyond the mother’s whim and encompasses physicians and their employers. Catholic institutions also have rights to have their moral imperatives honored by their employees.

Again, this case has been one of selective (and illegal) leaks to create spin against Bishop Olmsted, which buttresses my suspicions that this nun was already rebellious and that there is more to this case than meets the eye.

“By decrying the principle of choice and free-will, you make clear you do not regard any woman – not even a saint – as having moral worth.”

The logic of this statement simply escapes me. Free will extends to our procuring by illicit means that which is illegal. It is precisely that capacity to even procure the illegal, should we decide to do so, that gives us full moral worth, as only the free-will choice to love (self-sacrificially if need be) is what aids in our sanctification and perfection as human beings. We do not need legalized abortion as a means of guaranteeing our moral worth.

Your comments lead one to that conclusion by suggesting that the death of the mother is the only option here.

Well, I think that’s part of what I mocked in the post I initially read: your apparent NIMBY reaction that the problem wasn’t that this woman’s life was saved, the problem was that her life was saved in a Catholic hospital. And I’m sorry now I mocked, because that’s never helpful and you’ve been extremely polite.

But I gather that this Catholic hospital runs an emergency room, and that the woman was brought in as an emergency patient. She was dying when she got to the hospital, and the medical opinion was that trying to move her to another hospital would have killed her. Assuming that all of these facts are correct, that left the medical staff at that Catholic hospital with two choices: stand by while this woman died, and the fetus of course died with her; or perform an abortion in order to save her life.

I believed, and apparently Sister McBride also believed, that Catholic doctrine didn’t actually require Catholic hospitals and doctors to stand by and do nothing if that choice meant the death of a pregnant woman. But this reaction has clarified that, at least for the Diosece of Phoenix: better for two to die than one.

The logic of this statement simply escapes me.

Well, to praise Doctor Molla’s choice, she must have the right to make that choice. If you feel no woman ought to be allowed to make the choice between abortion and continuing pregnancy, you feel Doctor Molla ought not to have been allowed to make the choice for which she was sanctified: you deny her moral worth, and indeed that of every woman.

Thank you, but no need to apologize. There actually is a NIMBYish component at play here. While we would prefer that abortion be illegal, and that women would never seek recourse to it, the simple fact is that it is the law of the land. Its availability is widespread, with 52 million babies having been aborted here in the US since 1973, 1.8 BILLION worldwide since 1960.

While Catholic hospitals are powerless to stop the practice in its entirety, we can indeed stand and proclaim: Not In My Back Yard! And we have the right to have our freedom of belief and the administration of our back yard, which stems from that belief, respected. Especially by our employees.

The choice that we praise in Dr. Molla is in choosing life over death for her baby. Whether that death is procured by legal means or illegal means, its availability has always been with us. Whether abortion is procured illegally or legally, the choice to do so is always before the mother. Making the choice does not require a legal right to do so. Making the choice is a free-will act, though in choosing abortion, there are often elements of compulsion by others involved that mitigate the subjective guilt imputed to the mother.

Back on topic, the moral worth of the mother resides in her being made in the image and likeness of God, who is Love itself. Love is always a freely chosen response to another, or else it is not love. I’m certain that on this you and I share substantial agreement. Our ability to love is a large part of our dignity. Whether we choose love or not, and if we choose not to by legal or illegal means, the capacity to choose love is the sign of our moral worth.

The tragedy of abortion, 1.8 Billion since I was born, is that so very many people chose despair over love.

Gerard, your edits to my Diatribe haven’t shown up here at my end. All of the two posts are here, in all their disagreeable glory. I think they’re pithy and punchy, myself, but I see how it works better for you to dismiss me as a religious bigot. Hilariously funny, as well. Thanks. I needed a laugh – really desperately after reading all this denial of the right of conscience.

I’m not here to disagree with you, and humbly suggest a different POV. I’m here to register my disgust at your appropriation of the word Catholic, and your sanctimony. You have not had the courage yet to say “yes, I would have let that woman die” and how that sits with your duties as a doctor; and you continue to posit that Sr. MacBride acted against her faith when the only person who can tell us that is God. Shame on you.

People are receiving the mistaken impression that you and Bishop Olmsted are representative of our Church. That needs to be rectified.

Mary Catherine
“Would I ever consider killing one of my born children to save the life of the mother?”

Perhaps I’m missing the context, but that question makes no sense to me.

The issues/suppositions are: a) a pregnant woman is experiencing a true, life-threatening illness that is resulting from her pregnancy. b) the pregnancy cannot continue to the point where the baby is viable without the mother dying, and, by virtue of such, the baby dying, too.

It does matter that here that the child is unborn because its status is contained wholly within the physical condition that will cause the mother’s death, and eventually its own. Why lose two when you can save the one? Gerard answered according to his/the Church’s stance, which which I disagree.

MC, you are correct in that, say I had an abortion, I could die the next day in a car accident. I cannot control that. But I will control my fate to the best of my ability. If that means that I must sacrifice my unborn child (which is contained within the pregnancy that is causing my life-threatening situation) to give myself a chance at surviving to raise my born children into adulthood. And, touching on another related topic, if it were likely that future pregnancies would be problematic, either my husband or I would get sterilized. (I’m sure I know what yours and Gerard’s viewpoints on that issue are.)

As for my surviving children, I would tell them what happened, and that life isn’t fair, and often times they might have a situation in which one option isn’t better than the other, but only less worse, and they will have to reconcile their faith with their actions as I did. If they are happier and healthier having had my presence during their journey to adulthood (and beyond, if we were all so blessed) than
not, then my decision was correct.

You (and Gerard) form your viewpoint according to RC Church doctrine, while I do not. “And never the twain shall meet.”

You raise several issues in your posted comments, and I shall address them, I hope to your satisfaction.

First, as to your contention that Bishop Olmsted is missing data and not in a position to know with certitude if a line has been crossed, that simply is untrue from the standpoint of Roman Catholic moral theology and the bioethics that issue forth from those moral norms. I am certain that you are well-acquainted with the Principle of Double-Effect, which in essence allows for the removal of a diseased organ in order to save the life of the mother. The stipulation is that the organ containing the child (tube or uterus) is sufficiently diseased that it would certainly kill the mother prior to bringing the baby to viability at 23-25 weeks. In performing the procedure, the unintended consequence is the death of the baby, which is nevertheless an objectively evil action.

In the Phoenix case, the deliberate and intended action was the killing of the child. It was a direct targeting of the baby for death.

In Roman Catholic Christian anthropology and moral theology, both mother and child have equal human identity and moral standing as human beings, as human persons. It is impermissible to deliberately kill the one in an attempt to save the other. Bishop Olmsted, a Doctor of Canon Law, understands the rationale behind this better than most. Sister McBride too understood this, as well as the penalty for formal cooperation in procured abortion. The penalty is automatic (latae sententiae) excommunication. It is not imposed by a bishop or court, but is an automatic cutting off of oneself from the Body of Christ by one’s very actions. It ranks with desecration of the Eucharist and murdering a Pope.

As for your gratuitous dig regarding pedophile Priests not having been excommunicated, that is a line of argumentation made this week by NPR.

The line of argumentation in the NPR article that suggests as much illustrates a dangerous conflation of issues and ignorance of morality and justice.

There is no doubt that the sexual abuse of children is truly horrifying, whether by a Priest, a parent, a school teacher, scout leader, or any other person betraying a position of authority and trust. Whether or not that abuse merits excommunication is an argument that I would love to see vetted by moral theologians and canon lawyers.

Suppose it were an offense that merited excommunication? Further suppose that pedophile Priests incurred the penalty. Excommunication is a penalty intended as a medicinal remedy. Readmittance to the Church is made through confession to a Bishop (unless he delegates that authority to his Priests). Even if all of that were already operative, it would have no bearing on the intrinsic merits or demerits of the case in Phoenix.

Further, the Pope is the one with the authority to promulgate canon law. The NPR piece deceptively leads one to the erroneous conclusion that Bishop Olmsted, or any other Bishop, has discretion in excommunicating pedophiles, when in fact he doesn’t. Bishops can only adjudicate as much as Church law allows them to adjudicate, and I have not heard of Bishop Olmsted being implicated in cover-ups of pedophiles.

Yet this will be the new narrative when going after other abuses, “But what about the pedophiles…?” The pedophiles are now being dealt with decisively.

Returning then to your concerns, I do believe that I characterized your position well from your initial comments. If I have not, please detail for me how this is so.

I take issue with the following that you wrote:

“Fortunately it is uncommon, BUT THAT IS VERY DIFFERENT FORM CONTENDING IT IS NOT LIKELY TO HAVE HAPPENED IN THIS CASE. If it was a common enough occurrence a consult to the ethics committee would not have been necessary.”

In your initial comments, you claim to have seen only three sudden, acute cases of PHT in twenty years as a specialist. That’s one case every 6.7 years, which qualifies as rare. Though there are medical treatments both standard and experimental, you stated in your original post:

“2 – An abortion early in the pregnancy of a patient like this is far safer than taking a wait and see
attitude.
3 – To deny this mother lifesaving medical care at the time of the admission denied her access to long term therapies that might save her life.”

However, Catholic bioethics and morality requires that every effort be made to save both patients’ lives. Your approach in #2 is a direct contravention of this principle and practice.

Further, the convening of a bioethics panel for something which is expressly forbidden is an exercise meant to give cover to the institution for something a priori known to be morally evil. We do not engage in morality by consensus in the Catholic Church.
The ethics panel made a decision, and now would mandate that the entire Magisterium of the Church be guided by their decision’s precedent, effectively usurping Apostolic Authority, particularly divinely instituted Papal Authority of the Pope as the sole law-giver.

No. The answer is no.

This same group has engaged in a slow, selective leak of information to carefully craft a narrative wherein they are the heroes. Along the way they have essentially betrayed this woman’s identity by divulging her age, month of admission, pregnancy, condition, and course of action. Anyone who knows this woman knows the identity of the individual being discussed, and can divulge that to all the world if they so choose. It’s a dirty, scummy tactic that may well comprise a violation of HIPAA law. To say the least it is unethical, but to quote Scarlet O’Hara after she murders the Yankee soldier in Gone With The Wind,

The tragedy of abortion, 1.8 Billion since I was born, is that so very many people chose despair over love.

That’s extraordinarily arrogant of you to presume that you know why each one of those abortions was performed. (Like most arrogantly sweeping statements, it’s also wrong, but you evidently lack the humility and charity required to know it.)

Back on topic, the moral worth of the mother resides in her being made in the image and likeness of God, who is Love itself. Love is always a freely chosen response to another, or else it is not love.

Agreed. That’s why I’m pro-choice. Abortion ought to remain safe, legal, and readily available to any woman who needs it, and it ought always to be her final decision whether she needs. To keep abortion rates low, everyone ought to have effective contraception freely available and be taught well before they would decide to have sex, than whenever they have sex, they use contraception unless they want to engender a baby.

Unfortunately, as I’m aware, the Catholic position is in substantial disagreement over this, preferring high abortion rates to low rather than prevent abortion by promoting contraception.

As you note, illegal abortion – more safe than childbirth, less safe than legal – is always available to woman who have elective abortions simply because they don’t want to be pregnant. The high maternal death and morbidity rates in countries where pro-life legislation is partly because of the illegal abortion rate, and partly because doctors are forced by the law of the land to stand by and let a pregnant woman die rather than try to save her.

I’m certain that on this you and I share substantial agreement.

I’m quite certain we don’t. No one who believes that women are made in the image and likeness of God could possibly advocate that they should be forced to die rather than access safe legal abortion. No one who genuinely felt human love and compassion could possibly argue, as you do, that it’s better for a pregnant woman to die than to live. I see a vast chasm between us, and you’re on the side of death and indifference.

Which you claim is God’s side, and as an atheist, I have to accept your belief in an unloving God who prefers women to suffer and die rather than live and love. I believe that it matters more what people do with their beliefs than what the beliefs are: your beliefs, as those of Bishop Olmsted, and other Catholics, lead to mass death and awful suffering in countries where they are imposed by law, and would have meant one pregnant woman dead in hospital in Phoenix if not for Sister McBride. You say God wants it that way, fine, that’s your religion: I just don’t think a religion of death has any business being in charge of a hospital – let alone a country.

[…] save their lives?) (I felt slightly sorry for mocking because Nadal was very polite when I joined a discussion here, but he did acknowledge in the course of the discussion that there was a NIMBYish element to his […]

[…] Nadal nor Bishop Olmsted has ever in his life been faced with a decision of such moral magnitude. For him, the death of a woman in pregnancy is something unreal and distant, a halo and an odor of […]

I have some straight forward and simple questions for you that would need to be answered for this discussion to progress as an intellectually honest exercise:

1- As I asked in all posts, you suggested “Other of your colleagues would beg to differ with you on this approach to the management of both patient’s lives.” I have to ask if those are physicians who have cared directly for patients with Pulmonary hypertension in this situation?

2 – In the rare BUT still experienced medical situation where there is a CLEAR CHOICE of loosing 2 lives or saving one …no other choice possible, is it acceptable to lose both lives. You have cited cases where a mother has offered to give up her life to save her child and that was quite acceptable to you and the church. What if it were (as may be in this case) the other way around…..The Fetus would die regardless. Would it still be wrong to save the mother?

3 – If an ethics committee is purely cover for an unacceptable decision, why have an ethics committee in the first place? If all medical care is black and white to the church, and if there is a clear dogma to be followed, why does any Catholic hospital have an ethics committee?

4 – You indicate that “This same group has engaged in a slow, selective leak of information to carefully craft a narrative wherein they are the heroes. Along the way they have essentially betrayed this woman’s identity by divulging her age, month of admission, pregnancy, condition, and course of action.” If this is true, regardless of the circumstance, you have a HIPPA violation as you mention. It you do, has anyone sought to bring the hospital up on charges? Do you have data to support your charges?
Dr Nadal

I have some straight forward and simple questions for you that would need to be answered for this discussion to progress as an intellectually honest exercise:

1- As I asked in all posts, you suggested “Other of your colleagues would beg to differ with you on this approach to the management of both patient’s lives.” I have to ask if those are physicians who have cared directly for patients with Pulmonary hypertension in this situation?

2 – In the rare BUT still experienced medical situation where there is a CLEAR CHOICE of loosing 2 lives or saving one …no other choice possible, is it acceptable to lose both lives. You have cited cases where a mother has offered to give up her life to save her child and that was quite acceptable to you and the church. What if it were (as may be in this case) the other way around…..The Fetus would die regardless. Would it still be wrong to save the mother?

3 – If an ethics committee is purely cover for an unacceptable decision, why have an ethics committee in the first place? If all medical care is black and white to the church, and if there is a clear dogma to be followed, why does any Catholic hospital have an ethics committee?

4 – You indicate that “This same group has engaged in a slow, selective leak of information to carefully craft a narrative wherein they are the heroes. Along the way they have essentially betrayed this woman’s identity by divulging her age, month of admission, pregnancy, condition, and course of action.” If this is true, regardless of the circumstance, you have a HIPPA violation as you mention. It you do, has anyone sought to bring the hospital up on charges? Do you have data to support your charges?

I have never been a Catholic nor could I ever be one. That said, I think I have a pretty good understanding of Catholic doctrine in this area, and perhaps can offer some outside perspective. I am frankly appalled at the way in which some of you have twisted the stance of the Roman church here.

First, it’s not a case of the Roman church agreeing both should die rather than that one should be saved. To represent the position that way is to defame the Roman church on the basis of false statements. The Roman church holds that the doctor must try to save both lives. Not succeed, necessarily, but try. This means the doctor may not directly kill the baby. In the case of a pregnancy of 11 weeks, it would be impossible for the baby to live for any length of time if separated from his mother, but that still doesn’t justify deliberately tearing him limb from limb. This is really a false dilemma: either the doctor should be allowed to tear the baby limb from limb, or the mother will die. There is also the omission of several important facts, not the least of which is that abortion is very dangerous for a mother, and could actually CAUSE her death. It doesn’t matter whether it’s legal or not; it is a major assault on a woman’s body. If a woman is that close to death, it is not at all clear that subjecting her to this additional stress will help her in any way. Pro-choice people are already believing in one simply false idea: that abortion can be safe. By its very nature, it is dangerous because it is a major assault on a mother’s body, even if done in the best possible way. So some people believe a myth, and then turn around and condemn people who aren’t that gullible.

Second, the issue of pedophilia is irrelevant. And bringing it up is an attempt to poison the well. Just because one intrinsic evil was committed doesn’t mean we should condemn people for refusing to commit another.

Third, with all due respect to the doctor who has treated PHT, it is not at all clear to me that abortion was the best method to save this mother’s life. In my personal experience, someone who accepts abortion as an ethical component of medical practice (which it really is not), may have warped medical judgment. I’m not saying this particular doctor does, but it would be well for her to think about it. Is it possible that given the uncertainty of the prognosis of the mother in this case, refraining from a major assault on her body would be more likely to aid in her survival? We don’t know.

I am not saying that there is never, ever a case where an abortion would be less dangerous for the mother than allowing her either to carry, or to take the baby without directly killing him or her. However, the tendency is to resort too facilely to abortion rather than trying the more difficult course so that both have a chance. I can tell you from personal experience that some people who think abortion is ethical or in some way acceptable often are unwilling to look for that third answer. I know this because a person told me that I had to choose between possible death on the one hand, and letting him operate on the other. I chose neither, and I am here to tell you about it. But the bottom line is this: is it true that a major assault on a mother’s body by means of abortion is safer than doing the best one can to help her without such an assault, or is this just a product of the propaganda that making abortion legal makes it safe? The claim that abortion is ever safer is just propaganda. Before making false and fraudulent claims about abortion, please learn the facts. Maternal deaths from abortion are being swept under the rug.

There is no way that the commission of 1.8 billion abortions represents anything other than mass despair. The vast majority of abortions are committed on healthy women. There is no way that abortion was in their best interests. A woman and her baby are a dyad. Harm the one, and you harm the other. Sooner or later, the harm to the other will make itself known. And people who talk about “choice” never explain why it is only the abortionist who gets to exercise choice. Few mothers do. Most are coerced or deceived. The baby has no choice, and neither do grandparents, fathers, or siblings. The word “choice” was very clever, but it’s completely false. You must always finish the sentence. Choice to do what? To kill an innocent human being. No civilization can endure if this is permitted. And you know what? I have never seen any person who claims to be pro-choice fight for legislation to protect the right of a woman to refuse abortion. Paying lip service to this isn’t enough.

To summarize, this is not a question of whether or not a Catholic hospital allows a woman to die. It’s about finding an ethical and humane way of doing its best to save both lives. Even if the baby only lives a few minutes once removed, directly taking that life would brutalize everyone involved. We are not guaranteed a long life, but our Creator gave us the right to live our life, however short it might be. It makes me angry to see people put it in terms of, oh the hospital must let the woman die. I understand there are other treatments. Use them! Even if they don’t work, try them first. If they don’t work, it’s not clear abortion would help anyway.

As they say, hard cases make bad law. This is one of those hard cases of which this saying speaks.

Pat
You are flinging propaganda and as is your first amendment right, you are expressing your opinion, but you are wrong in your understanding of medical facts. Have you ever had experience with a person with pulmonary hypertension who is gravely ill?

Fact: “The risk of death associated with abortion increases with the length of pregnancy, from one death for every one million abortions at or before eight weeks to one per 29,000 at 16-20 weeks-and one per 11,000 at 21 or more weeks.” Guttmacher Institute

Fact: (from eMedicine)
IPAH has no cure. Untreated, IPAH leads to right-sided heart failure and death. The OVERALL survival rate in one study was approximately 30% at 3 years. Prior to the 1990s, therapeutic options were limited. The recent emergence of prostacyclin analogues, endothelin receptor antagonists, phosphodiesterase-5 inhibitors, and other novel drug therapies has greatly improved the outlook for patients with IPAH and IPAH-like diseases. In one study, the use of long-term prostacyclin agents resulted in a 5-year mortality rate greater than 65%. With newer therapies, perhaps in combination, these figures are expected to further improve.

Fact: The mortality rate for untreated IPAH is approximately 50% at 3 years (BUT THIS VARIES WITH SEVERITY AT PRESENTATION). With epoprostenol therapy, this has increased to higher than 65% at 5 years. Data on long-term survival in patients treated with other pulmonary vascular therapies are emerging. Patients whose disease progresses and is unresponsive to medical treatments either undergo transplantation or die of progressive right-sided heart failure.

Fact: Pulmonary hypertension is caused by thickening of the muscle and skin layers in the small lung arteries over a long period of time. This does not just melt away when medical therapy is started and in fact until only a few years ago the only real (though terrible) theraputic option was lung or heart lung transplant, and even with this patient mortality was exptremely high.

Fact: The worse the disease is at presentation, the higher the morbidity and mortality rate is approaching 100% when patients present with stage IV disease in severe right heart failure.

Fact: Pregnancy in patients with pulmonary hypertension makes the disease more malignant due to the hormones released in the process of being pregnant, due to the hemodynamic stresses places on the heart due to pregnancy, and possibly due to other factors

Now the facts (as we know them in this case):
The mother was only 11 weeks pregnant. At this age the fetus is not viable and would not be for at least 13 more weeks
The mother was in critical condition and the condition was so critical that she could not be transported. In other words, this mother was dying. That would place her in the highest risk category of those with pulmonary hypertension and this is the group whose mortality rate approaches 100%.

Now the conjecture part, but as others on this list have freely used conjecture, I think it is fair for me to use as well.
In a Tertiary Care Center, which I think this hospital was, this mother would already have been getting the maximum medical therapy available
If, in a Catholic Hospital, pregnancy termination was even being considered, the patient would still have been critically ill on maximum support.
The fact that they called in their ethics committee means they were looking for an outside committee (separate from the physicians and nurses directly associated with the case) to second guess them, but it appears that after a thorough review, the ethics committee also felt there was no other acceptable choice.

Now after all this, the pregnancy termination would not have proceeded without secured consent from the mother or if she was too ill (ie sedated to limit the work of her right heart) the husband or whoever her medical power of attorney fell to.

Now after all this, I still have to ask a question that no one has yet answered here:

What if it were (as may be in this case) that The Fetus would die regardless, even if maximum medical management were perused because the mother’s life was lost. Would it still be wrong to try and save the mother instead thus saving one life instead of losing 2?

The problem is that the dilemma to be resolved became the baby not the pulmonary hypertension. There are pharmaceutical treatments for pulmonary hypertension. They are, however, contraindicated during pregnancy. In this case, the pregnancy already existed and had to be considered another living patient at risk of pulmonary hypertension. If the only way to treat the underlying issue was to administer the medication that would pose potentially harmful risks to the fetus, one would have to assess it based on the principle of double effect at which point one might conclude that the treatment for the disease constituted a necessary risk. I am not suggesting a treatment option, rather I am offering that there were other options to consider in lieu of abortion. In no uncertain terms is the answer to the problem the elimination of the life of the child, but the loss of the life of the child can be justified if it is not clearly intended as a result of the treatment of the mother.

“To summarize, this is not a question of whether or not a Catholic hospital allows a woman to die. It’s about finding an ethical and humane way of doing its best to save both lives. Even if the baby only lives a few minutes once removed, directly taking that life would brutalize everyone involved. We are not guaranteed a long life, but our Creator gave us the right to live our life, however short it might be. It makes me angry to see people put it in terms of, oh the hospital must let the woman die. I understand there are other treatments. Use them! Even if they don’t work, try them first. If they don’t work, it’s not clear abortion would help anyway.

As they say, hard cases make bad law. This is one of those hard cases of which this saying speaks.”

Thank you Pat for speaking clearly (and Gerard Nadal, too, for his very good, detailed remarks. This is the truth, and it is as simple as you state. This doesn’t have to do with being Catholic or not; it has to do with being human.

I understand how it is easy to get caught up in the medical details, but I have a question, for those who think that we ought to base our actions simply on what we think will be the outcome, rather than on basing them on the dignity of each life involved–i.e. that direct intentional taking of innocent life is always wrong. So let’s say you are a Jewish family hiding from the Gestapo, and you are in a closet with your family, one of whom is a small child. The Gestapo are coming, the child begins to cry, and you have no way of stopping the noise. You are morally certain that they will find you. Do you have the right to suffocate that child, in order to save your life and that of your family? Maybe we should simplify the situation by saying it’s just you, the mother, in the closet with the baby, and the rest of your small children are safe in another place. Would you find it morally justifiable to kill the baby because the rest of the children need you to raise them? I would really like to know how you would view that situation. It seems that you think it is inhumane even to consider not aborting, so I would think that in this case you would think it inhumane for that mother not to strangle her little child. The reason I’m asking this is because I’m not certain that you are clearly holding the unborn child to be fully human, and if you answer yes, that the mother should strangle her born child, then it will be clear to me that you do hold the unborn child to be fully human, and perhaps there will be better definition to the debate.

I am pregnant and bipolar. I am 34 yrs old and took no precautions during sex to prevent this pregnancy. This is my 5th pregnancy resulting in 2 healthy girls and 2 abortions. My abortions were semi-forced by my partner… after which we tried to maintain birthcontrol methods and failed. My postpartum experience last time was the scariest and most dangerous exprience of my life. To put it delicately I was in post-partum psycosis and hearing voices hallucinating and made threats to kill my children and myself. I admitted myself and got the bipolar diagnosis and treatment. Was released 3 months later episode free and anxious to get my life back to normal. It is my belief that what lies ahead is not unfamiliar and can be overcome with prayer and a strong support system in place. Knowing the warning signs and the medication to head this thing off I am going thru with my pregnancy with optomism and faith that God doesn’t give me more than I can handle and that with his strength I will see this through to a happy ending. I know that I brought this situation on myself and am harder on me than anyone eles can be. Im also believing for a miracle here and must remain positive and hopeful expecting GOD’s grace.

I have avoided taking this up until now because I think this carries the discussion away from it’s intended course BUT it has come up a few times and so I feel obliged to correct the record. I hope you will all agree that one mainstream religion is not superior to another and if you do, I hope you never find yourselves in the minority or in need of understanding and tolerance of those you have not shown tolerance to.

Whether you consider a fetus to be a person is a religious and cultural concept. In fact, whether you consider a child a whole human being is a religious and cultural concept. That is a fact regardless of how badly that sits with you or how much you want to argue it. A simple example: In Jewish tradition (since everyone keeps bringing up the Holocaust), a fetus is not a whole person until the child’s head is being delivered (if not breach) or once more than half the child has been delivered. Prior to that point, the fetus is a ‘partial person’, and the life of the mother is more important until birth in Jewish law. Therefore, if saving the mother can only be insured by terminating a pregnancy, there would be no question about trying to save the fetus.

This discussion has been about what should happen at a Catholic Hospital and as it should, that is ruled by Catholic law. But please do not mistake that the Catholic world view is the only moral view, or the only right view. There are so many shades of gray here, you can not imagine. I have said it elsewhere but will say again, this is why ethics committees are so important. In my interactions with them, they have always earned their keep.

The truth of the matter is that a new human organism comes into existence at fertilization. It is a separate organism on its own developmental trajectory, developing through the first of several developmental stages that will continue for decades after birth. It is in every sense a human being, a human organism. The only thing it lacks is full legal standing because of a decision made by seven men in black robes. How is it possible to do fetal surgery if the organism on which you are operating is not a human being? How do you bill insurance companies for performing veterinarian surgery in human-only facilities, as you have declared the object of the surgeon’s manipulations to be non-human? To my knowledge, MD’s don’t practice on non-humans.

I’ll have a full answer to your list of questions with a list of my own in the morning. It’s been a hectic day here.

However, Jewish Law has no standing in this discussion as we are not discussing a secular hospital. In Roman Catholic Hospitals the entity which you declare not human is recognized as such, with strong backing from the field of embryology. It enjoys full moral worth with its mother. And it is never, NEVER permissible to target it for death.

As for your patronizing tone, I ask that you keep that in check and we keep this civil. I’m a Ph.D. medical microbiologist who knows his way around a hospital quite well and has served on IRB’s and ethics committees. When a committee meets, they begin with the known and acceptable standards of morality, law and ethics to guide them. In a Roman Catholic Hospital, the direct killing of a baby in this case falls outside of the Principle of Double Effect, posted here for your convenient perusal:

Therefore, the committee meeting shouldn’t have even been called. It’s simply not permitted to tear a baby apart in order to save the mother, regardless of whether the baby will live or die otherwise. That sounds tough, but that’s simply the way it is with us. Sister McBride dispensed her staff from moral law and church law and now finds herself excommunicated by her own actions, and removed from her position by her Bishop.

There are certain verities in life Dr. Becker. Prohibitions against murdering the innocent is one of them, even if one believes the innocent will soon die.

“I hope you will all agree that one mainstream religion is not superior to another and if you do, I hope you never find yourselves in the minority or in need of understanding and tolerance of those you have not shown tolerance to.”

I find this strangely out of place in this discussion. We are trying to discuss, aren’t we, the objective morality involved in a situation where a mother’s life and a baby’s life is in the balance, and trying to determine what is the ethical course of action, right? So far I don’t think anyone has been “intolerant” of you or anyone else in the discussion, so could we just go ahead and speak about the matter at hand?

What I am saying is that I believe that it is just as accessible to reason, and to reasonable people, that human beings in the womb are real human beings and worthy of being cherished and protected, just as a human being outside the womb. I knew this long before I was Catholic. So I’m not at all making a claim about religion; I’m talking about something which I think even little children can know, regardless of religion.

So it seems to me, in your reply (please correct me if I am wrong) that you are saying that since different religions and world views claim different things about the fetus, then it is impossible to really demand that the fetus really be treated as fully human in the way that we demand that a born child be treated as fully human. Is that your view?

This is a bit of an aside, since I think Dr. Nadal really wants to make the more limited point that this was a Catholic hospital and it should simply uphold Catholic standards, and he is right, but I also would hate to see this finally being viewed as simply a matter of Catholic positive law not having to do with the fundamental obligations and rights of human beings as human beings.

“This is a bit of an aside, since I think Dr. Nadal really wants to make the more limited point that this was a Catholic hospital and it should simply uphold Catholic standards, and he is right, but I also would hate to see this finally being viewed as simply a matter of Catholic positive law not having to do with the fundamental obligations and rights of human beings as human beings.”

You’re right Rebecca. I’m focussing in the narrow sense on the case in question, but I hope that the the rationale behind the Church’s position, the human identity and equal moral standing of the fetus, is coming through at the same time.

Dr. Becker: You are flinging propaganda and as is your first amendment right, you are expressing your opinion, but you are wrong in your understanding of medical facts. Have you ever had experience with a person with pulmonary hypertension who is gravely ill?

My response: No, I am not flinging propaganda. I have been studying abortion from a medical and scientific standpoint for 40 years. I know what I am talking about. And no, I haven’t had that experience. I don’t have to, to know how damaging abortion is for a woman. Why would any discerning doctor subject such a woman to the ADDITIONAL stress of an abortion, instead of treating her PHT right away? It makes no sense; it’s not even logical.

Becker: Fact: “The risk of death associated with abortion increases with the length of pregnancy, from one death for every one million abortions at or before eight weeks to one per 29,000 at 16-20 weeks-and one per 11,000 at 21 or more weeks.” Guttmacher Institute

My response: NOT A FACT! These people have a conflict of interest. You can’t trust them. They are, for all practical purposes, an arm of Planned Parenthood, and PP MAKES MONEY OFF ABORTION. LOTS of money. Billions of dollars.

READ the medical literature as I have. Study all the cases where cause of death was FALSIFIED and thus, they can “justify” these false statistics.

Dr. Becker: Fact: (from eMedicine)
IPAH has no cure…
Fact: The mortality rate for untreated IPAH is approximately 50% at 3 years…
Fact: Pulmonary hypertension is caused by thickening of the muscle and skin layers…
Fact: The worse the disease is at presentation, the higher the morbidity and mortality rate is approaching 100% when patients present with stage IV disease in severe right heart failure…

My response: And all of this makes abortion good medical treatment?

Dr. Becker: Fact: Pregnancy in patients with pulmonary hypertension makes the disease more malignant due to the hormones released in the process of being pregnant, due to the hemodynamic stresses places on the heart due to pregnancy, and possibly due to other factors

My response: Now this doesn’t make any sense. You told us this woman was in imminent danger of dying. Doing an abortion on her would NOT restore her hormones to normal pre-pregnancy levels immediately. Normally, it takes at least a couple of weeks. They didn’t have that kind of time. Why not just repair the heart, as you ultimately did? Why not do that FIRST? Here’s another thought. After repairing the heart, for good measure, give her treatment with her own adult stem cells.

Becker: Now the facts (as we know them in this case):
The mother was only 11 weeks pregnant. At this age the fetus is not viable and would not be for at least 13 more weeks
The mother was in critical condition and the condition was so critical that she could not be transported. In other words, this mother was dying. That would place her in the highest risk category of those with pulmonary hypertension and this is the group whose mortality rate approaches 100%.

My response: Now why does this necessitate abortion? Take the baby out from her intact. Or take her uterus. If she was dying, her uterus wouldn’t be missed anyway. You don’t have to hack the baby apart to save her life. You should NOT subject her to this kind of stress when she is dying! Use what little strength she has left to do the operation that MATTERS. REPAIR HER HEART!

Becker: Now the conjecture part, but as others on this list have freely used conjecture, I think it is fair for me to use as well.

My response: fair enough.

Becker: In a Tertiary Care Center, which I think this hospital was, this mother would already have been getting the maximum medical therapy available
If, in a Catholic Hospital, pregnancy termination was even being considered, the patient would still have been critically ill on maximum support.
The fact that they called in their ethics committee means they were looking for an outside committee (separate from the physicians and nurses directly associated with the case) to second guess them, but it appears that after a thorough review, the ethics committee also felt there was no other acceptable choice.

My response: Again, this makes no sense. Why take the time to have that kind of discussion? That would take far longer than transporting her to another hospital five or ten minutes away. If she were in a hospital that didn’t have the facilities to provide the kind of intensive care she required, she would be transported. Do it in reverse! Don’t waste time on an ethics committee. Take her elsewhere!

Becker: What if it were (as may be in this case) that The Fetus would die regardless, even if maximum medical management were perused because the mother’s life was lost. Would it still be wrong to try and save the mother instead thus saving one life instead of losing 2?

I am going to answer that question. DON’T hack the baby apart. Remove him or her intact and give comfort care! It wouldn’t be any harder on the mother. Not removing the baby at all would use LESS of her strength. You’re not making sense! Fix her heart, and then the pregnancy hormones just might not kill her. Even if they could, the abortion could also kill her. Do the ethical thing. Fix her heart. Stop wasting time on ethics committees and medical rape.

You’re conflating the immediate emergency with the long-term prognosis. YOU CANNOT REDUCE HER PREGNANCY HORMONES IMMEDIATELY by doing an abortion. It takes time for her body to reduce the hormones. If she lives that long, there is time to repair her heart. If she doesn’t, abortion is irrelevant anyway.

We’ve talked about false dilemmas. Here’s another one. Why didn’t anybody put her on an artificial heart and then treat her?

Insisting abortion is the only answer is just plain laziness and, I maintain, poor medical judgment, growing out of thought processes that have forgotten about medical ethics.

Rebecca in CA, thank you for the clarity of your example of a child crying in the closet while the Nazis are searching. This scenario actually did happen in some instances. It is highly unlikely ANY parent suffocated the child. You can stop the cries from being heard without killing the child. Again, this is an example of how people can get snookered by a false dilemma.

Judith Becker: Whether you consider a fetus to be a person is a religious and cultural concept. In fact, whether you consider a child a whole human being is a religious and cultural concept. That is a fact regardless of how badly that sits with you or how much you want to argue it. A simple example: In Jewish tradition (since everyone keeps bringing up the Holocaust), a fetus is not a whole person until the child’s head is being delivered (if not breach) or once more than half the child has been delivered. Prior to that point, the fetus is a ‘partial person’, and the life of the mother is more important until birth in Jewish law. Therefore, if saving the mother can only be insured by terminating a pregnancy, there would be no question about trying to save the fetus.

My response: Oh please! Whether or not a fetus is a human being is a SCIENTIFIC question, not a religious one. Undeniably, a person’s life begins at fertilization. End of argument. We should ACCORD the legal designation of personhood on ALL human beings, without exception. So please don’t try this religious stuff on us. Dr. Nadal answered you very well. Until recently, ALL doctors (except back alley abortionists, but having repudiated medical ethics, they’re not doctors anyway) had moral clarity. Abortion is WRONG. It is a violation of MEDICAL ETHICS. It is NOT a religious issue.

Dr. Nadal: It enjoys full moral worth with its mother.

My response: I am going to call you on your rhetoric. NEVER call a human being “it”. Always call the unborn “he” or “she”.

Rebecca in CA

Dr. Becker,

“I hope you will all agree that one mainstream religion is not superior to another and if you do, I hope you never find yourselves in the minority or in need of understanding and tolerance of those you have not shown tolerance to.”

I find this strangely out of place in this discussion. We are trying to discuss, aren’t we, the objective morality involved in a situation where a mother’s life and a baby’s life is in the balance, and trying to determine what is the ethical course of action, right? So far I don’t think anyone has been “intolerant” of you or anyone else in the discussion, so could we just go ahead and speak about the matter at hand?

My response: I can’t think of any more INTOLERANT action than hacking a tiny, defenseless human being apart, can you?

[…] that the woman had a right to live: The Phoenix Abortion: A Pediatric Cardiologist Weighs In, More Debate on the Phoenix Abortion, More Debate With Dr. Becker on the Phoenix Abortion, How Catholic Bioethics is Guided, and The […]

Becker: a fetus is not a whole person until the child’s head is being delivered (if not breach) or once more than half the child has been delivered. Prior to that point, the fetus is a ‘partial person’, and the life of the mother is more important until birth in Jewish law. Therefore, if saving the mother can only be insured by terminating a pregnancy, there would be no question about trying to save the fetus.

“Whether you consider a fetus to be a person is a religious and cultural concept. In fact, whether you consider a child a whole human being is a religious and cultural concept. That is a fact regardless of how badly that sits with you or how much you want to argue it.”

Absolutely not. The question at hand is a human question. It is a human question because it involves human beings from all races and cultures.
It matters not what Catholics, Jews or Hindus believe.
Is the unborn baby a human person.
Science has the answer that it is a living human being.
Philosophy has the answer that every human being must be a person. For where would you draw the line at personhood? At viability?

What we are running into here is the fact that we human beings have a practice of defining inconvenient people out of the human race so we can brutalize them. The fact that a person would reason that an unborn child is not yet a human being with the right to life, because it’s a religious question, is this type of argumentation, and I would contend that reaching this conclusion means that the person lacks the philosophical foundation for making ethical decisions. Science has unequivocally answered the question of whether or not all instances of a new organism with human DNA is a human being or not. Such an organism is a human being, regardless of whether that organism is female, black, Jewish, or unborn, or not. Civilization exists solely because we have concluded that all human beings have been given the right to life at their creation. Creation occurs at fertilization. Whether or not this is a human being is a scientific question, not a religious one.

You just have to go back to Haeckel to decide that the conceived organism is anything other than a human being. Haeckel accepted the theory of evolution, and that’s a huge part of the problem. He constructed a false scenario on which he based the conclusion that “ontongeny recapitulates phylogeny”. Simply put, we start out as a one-celled animal, akin to an amoeba, and we progress through various stages of being a fish, a mammal, and so forth, until finally we become a human being. In service of this idea, he did a series of drawings, taking embryonic forms of different organisms and comparing them. The only problem is that the embryos he compared were from widely differing ages from their formation, and at the same stage, they do not resemble each other, but he picked and chose his examples to show similarity between species where none exists. Worldviews matter. Regardless of whether a person who aspires to the medical profession believes the unborn are fully human or not, the mother knows. You can’t do an abortion on a mother without brutalizing her. The designation “person” has historically been applied as a legal question. The purpose of withholding this designation from some people is so we can justify enslaving or killing them.

Western civilization has given recognition to the humanity of the unborn from the time of Hippocrates. This important concept has shaped our medicine and our science. It has shaped our societies. All of this has made the unprecedented liberty we enjoy possible. Without this concept, the bedrock of rights and of civilization has been undermined. This is happening in the modern world, and the consequences are disastrous. We have tens of millions slaughtered by brutal regimes like the Soviet, Sino, Germanic, and other regimes. This has now spread worldwide, and it is estimated that 1.7 billion human beings have been killed in cold blood. This is outrageous.

It is incumbent upon us to find a better answer. Most especially, the doctor who confronts a situation where it would appear that the baby’s continued existence will cost a mother her life, must strive to find another answer. I thank God for any medical entity, whether it be a professional or an institution, that will preserve the essence of our humanity. If any medical professional concludes that the baby is not fully human, that person has gone into the face of human civilization, has rejected medical ethics, and should not be practicing. If a medical professional recognizes that the baby is fully human, and operates on the assumption that it is his or her duty to try to save both lives, then I welcome that person as a potential caregiver. Even if the baby’s life can only be saved for a few minutes to complete his life, it must be done. The Roman church has chosen to establish this line in the sand, and we cross it at our peril. Whatever the rest of the world does, Catholic hospitals have a right to exist and to draw this line in the sand, and I have the right to CHOOSE to give my business ONLY to such hospitals.

A doctor who argues that the mother must allow an abortion in this very difficult case, and reveals her philosophical underpinnings as holding that the baby is not fully human and therefore not a person, until the birth of the head and subsequent breathing, is no longer qualified to give me medical care. It’s that simple. If the doctor believes the baby is fully human, but he or she can save only one life, the mother’s, and has the philosophy that the purpose is to save life first and foremost, then I will consider that person as a medical professional worthy of my possible business. The very idea that only people who will violate our fundamental humanity are allowed to practice medicine is morally bankrupt. If you want to go off and brutalize each other, you do it without my consent, and I will stay away from you. But civilization cannot tolerate this practice without losing its soul. And don’t implicate me in any way. The thinking that defines babies out of the human race on any grounds based on how old they are betrays itself in medical decisions. If a mother dies because she is pregnant, that is nature taking its course, and is NOT a KILLING. We do what we can, but in the final analysis, we’re not killers if we choose a different course and do the best we can.

Saying that the baby isn’t fully human is a betrayal of a philosophy that I do not accept. That is why whatever that person says medically is suspect. That’s why I don’t trust such a doctor with my care. That’s why abortion is seen as the better answer in this difficult case. That’s why we haven’t found a different answer.

“A doctor who argues that the mother must allow an abortion in this very difficult case, and reveals her philosophical underpinnings as holding that the baby is not fully human and therefore not a person, until the birth of the head and subsequent breathing, is no longer qualified to give me medical care.”

That should read,

“A doctor who argues that we must allow the mother an abortion in this very difficult case (i.e., there are no other options for her survival), and reveals her philosophical underpinnings as holding that the baby is not fully human and therefore not a person, until the birth of the head and subsequent breathing, is no longer qualified to give me medical care.”